title: [Therapeutic clinical approach for the elderly patient with hypertension: recommendations for clinical practice].
abstract: The incidence of hypertension in the geriatric population is very high and is a significant determinant of cardiovascular risk in this group. The tendency for blood pressure to increase with age in westernized societies such as the United States may depend on environmental factors such as diet, stress, and inactivity. Our population tends to become more obese; to consume relatively greater amounts of sodium and lesser amounts of potassium, calcium, and magnesium; and to decrease exercising with increasing age. Senescent changes in the cardiovascular system leading to decreased vascular compliance and decreased baroreceptor sensitivity contribute not only to rising blood pressure but also to an impairment of postural reflexes and orthostatic hypotension. The hallmark of hypertension in the elderly is increased vascular resistance. Greater vascular reactivity in the elderly hypertensive patients may reflect decreased membrane sodium pump activity and decreased beta-adrenergic receptor activity as well as age-related structural changes. Treatment of diastolic hypertension in the elderly is associated with decreased cardiovascular morbidity and mortality. Although treatment of systolic hypertension may not decrease immediate cardiovascular mortality, it appears to decrease the incidence of stroke. The initial therapeutic approach to the elderly hypertensive patient should generally consist of a reduction in salt and caloric intake and an increase in aerobic exercise, i.e., walking. Drug therapy should be initiated with lower doses of medication with a special concern about orthostatic hypotension.
authors.affiliation: Departamento de Cardiología Adultos III, Instituto Nacional de Cardiología "Ignacio Chávez", INCICH, Juan Badiano 1, secc. XVI, Tlalpan 14080, México DF. martinrp02@yahoo.com.mx
authors.forename: Martín
authors.initials: M
authors.lastname: Rosas
authors.forename: Gustavo
authors.initials: G
authors.lastname: Pastelín
authors.forename: Catalina
authors.initials: C
authors.lastname: Lomelí
authors.forename: Celso
authors.initials: C
authors.lastname: Mendoza-González
authors.forename: Arturo
authors.initials: A
authors.lastname: Méndez
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Lorenzo-Negrete
authors.forename: Jesús
authors.initials: J
authors.lastname: Martínez-Reding
authors.forename: Sergio Mario
authors.initials: SM
authors.lastname: Férez Santander
authors.forename: Fause
authors.initials: F
authors.lastname: Attie
mesh_terms: D000368:Aged; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D017410:Practice Guidelines as Topic